The War on Healthcare

The U.S. Military is often criticized for overspending on its convoluted bureaucracy. But when it comes to electronic patient records, Uncle Sam may just be the model of healthcare efficiency.

In the private sector, electronic health records are gaining about as much traction as a snowboard in quicksand. According to a September 2005 study conducted by the Medical Group Management Association, only 11.5 percent of all medical group practices have fully implemented an electronic patient-records system, despite President Bush's stated goal to have all such records digitized by 2014a deadline that critics say is far too aggressive.

"Adoption is tricky because of legal barriers and slow development of standards," says Thomas Leary, director of federal affairs for the Healthcare Information and Management Systems Society.

But the Department of Defense is more optimistic. It's in the process of rolling out AHLTA (Armed Forces Health Longitudinal Technology Application), an electronic health-record system for the 9.2 million active and retired service personnel and their families. Initiated in 1997, AHLTA stores patient history, lab test results, prescriptions, radiology reports and physical examinations.

At a cost of $1.2 billion, the system is available at two-thirds of all U.S. military treatment facilities around the world, including in Iraq.

When completed in 2011, it will encompass 140 treatment facilities in 13 countries. "The scope of this project is simply unprecedented," says Colonel Victor Eilenfield, who manages the program.

At military clinics and hospitals, healthcare providers access AHLTA through desktop PCs. The system is also being loaded onto wireless laptops for use on the battlefield. "Many of our medics carry PDAs that have an image of a body on it," Eilenfield says. "They can tap on the body to mark shrapnel and other wounds, and then sync that data up with AHLTA."

Why does the military need a digitized system? "We are highly mobile," says Eilenfield. "Our people move camps every few years, and are constantly moving on the battlefield. So it's important to provide a continuity of care." With the paper-based system, continuity was practically impossiblebecause of reassignments, servicemen were responsible for the delivery of their own patient data. "Hopefully, the records were turned in at the next post," he says. But too often, they were not.

And it got worse in combat: "We heard stories of files getting sucked up in the medevac helicopters during evacuations." AHLTA not only rids the system of paper, but alerts doctors to complications with prescriptions and procedures. "Plus, we can do symptom surveillance," Eilenfield says. For example, servicemen can be screened for symptoms that might indicate avian flu, or a biological attack. "We see it as a global early-warning system," he adds.

Despite claims that the 2014 deadline is unrealistic, Eilenfield says AHLTA is proof that the President's mandate can be met. "We're already two-thirds there, so it can be done."